cornea ppt

7/25/2019 Cornea ppt

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CLINICAL SpottersCLINICAL SpottersOF CORNEAOF CORNEA

JIJI K TJIJI K T

FELLOW OPTOMFELLOW OPTOM

THE EYE FOUNDATIONTHE EYE FOUNDATION



CORNEACORNEA

Cornea is a transparent , avascular , watchCornea is a transparent , avascular , watch

glass like structure . It forms anterior oneglass like structure . It forms anterior onesixth of outer fibrous coat of the e eballsixth of outer fibrous coat of the e eballan! it is the most sensitive an! !elicatean! it is the most sensitive an! !elicate

structure of the e e.structure of the e e.



"imensions"imensionsDiameter Diameter

Anterior #$$ mm %&' Anterior #$$ mm %&' # $( mm %)'# $( mm %)' *osterior + $$. mm*osterior + $$. mm

Radius of curvatureRadius of curvature Anterior + -. mm Anterior + -. mm *osterior + /. mm*osterior + /. mm

ThicknessThickness centre + 0. ( mmcentre + 0. ( mm

peripher + $.0 mmperipher + $.0 mmRefractive indexRefractive index + $.11 + $.11

Refractive power Refractive power + 22 " + 22 "



3a ers of cornea3a ers of cornea

1.1.EpitheliumEpithelium

2.2. Bowman’s membraneBowman’s membrane

.. !troma!troma

".". Duan’s la#er Duan’s la#er $.$. Descemet’s membraneDescemet’s membrane%.%. EndotheliumEndothelium



&a#ers of cornea&a#ers of cornea



Evaluation of corneal diseasesEvaluation of corneal diseases

!#mptoms!#mptoms painpain

!ecrease! visual acuit!ecrease! visual acuit haloshalos

photophobiaphotophobia lacrimationlacrimation



4igns4igns

EpitheliumEpithelium 55 erosions, oe!ema, filaments, spkserosions, oe!ema, filaments, spks!troma!troma 55

infiltrates, oe!ema, vascularisation,infiltrates, oe!ema, vascularisation,!eposits 6 scarring !eposits 6 scarring

Descemet’s membraneDescemet’s membrane 55

breaks, fol!s, localise! thickeningbreaks, fol!s, localise! thickening



Cont7.Cont7.

Deposition of pi'mentsDeposition of pi'ments 55it is associate! with a varietit is associate! with a variet

of !isor!ersof !isor!ers(orneal sensation(orneal sensation 55 loss of corneal sensation inloss of corneal sensation in

viral keratitis 6neuroparal ticviral keratitis 6neuroparal tickeratitiskeratitis



Diseases of corneaDiseases of cornea



Congenital anomaliesCongenital anomalies

8icro cornea8icro cornea



8icro cornea8icro cornea

9his is a rare unilateral or bilateral con!ition9his is a rare unilateral or bilateral con!ition

4igns4igns Corneal !iameter is $0mm or lessCorneal !iameter is $0mm or less

Ac shallow Ac shallow

Other !imensions are normal.Other !imensions are normal.



8egalocornea8egalocornea



8egalocornea8egalocornea

Rare bilateral, non progressive, enlargementRare bilateral, non progressive, enlargementof cornea.of cornea.

4igns4igns : Corneal !iameter $1mm or moreCorneal !iameter $1mm or more: "eep Ac"eep Ac: )igh m opia 6 astigmatism)igh m opia 6 astigmatism: Normal visual acuitNormal visual acuit



Cornea planaCornea plana



Cornea planaCornea plana

!i'ns!i'ns: 4evere !ecrease of corneal4evere !ecrease of corneal

curvature %; 5 (0#10"'curvature %; 5 (0#10"': ) permetropia) permetropia: 4hallow AC an!4hallow AC an!

: *re!isposition to angle closure*re!isposition to angle closureglaucomaglaucoma



4clerocornea4clerocornea



4clerocornea4clerocornea

: <suall bilateral con!ition<suall bilateral con!ition

: Opacification 6vasculari=ation ofOpacification 6vasculari=ation of

peripheral or entire cornea.peripheral or entire cornea.

: Restricte! to peripheral cornea #Restricte! to peripheral cornea #

sclerali=ation # cornea appear smaller.sclerali=ation # cornea appear smaller.



Corneal oe!emaCorneal oe!ema

!i'ns!i'ns

It associate! with increase! cornealIt associate! with increase! cornealthicknessthickness

A variable !ecrease in corneal A variable !ecrease in corneal

transparenctransparenc



Corneal oe!emaCorneal oe!ema

!#mptoms!#mptoms

Coloure! halosColoure! halos"ecrease! visual"ecrease! visualacuitacuit



>ullous keratopath>ullous keratopath

: In corneal oe!ema,In corneal oe!ema,epithelium raise!epithelium raise!into large vesiclesinto large vesiclesor bullaeor bullae

: 3ea!ing to bullous3ea!ing to bullouskeratopathkeratopath



Inflammations of the corneaInflammations of the cornea



>acterial keratitis>acterial keratitis

Commonest causative organismsCommonest causative organisms

:*neumococus*neumococus

: 4taph lococus4taph lococus: *seu!omonas*seu!omonas

: ?onococcus.?onococcus.




4@8*9O844@8*9O84 Acute pain Acute pain

Re!nessRe!ness3acrimation3acrimation*hotophobia*hotophobia

"ecrease! &A"ecrease! &Ahite spot on the corneahite spot on the cornea




4I?N44I?N4

8arke! blepharospasm8arke! blepharospasm3i! oe!ema3i! oe!emaCiliar congestion of theCiliar congestion of theconBunctivaconBunctiva) pop on ma be) pop on ma bepresentpresent

: Iop ma be increase!Iop ma be increase!:

gre ish white ,gre ish white ,circumscribe! infiltrationcircumscribe! infiltration



)ealing of corneal ulcer )ealing of corneal ulcer

ormation of fibrous tissueormation of fibrous tissueNot arrange! regularlNot arrange! regularl

9he refract the light irregularl9he refract the light irregularl9herefore the scar is more or less9herefore the scar is more or less9he scar is thin + opacit is slight +Nebula9he scar is thin + opacit is slight +Nebula

If rather more !ense + 8aculaIf rather more !ense + 8aculaIf still more !ense 6 white #3eucomaIf still more !ense 6 white #3eucoma



Opacities of corneaOpacities of cornea



"escemetocele"escemetocele

: Complication ofComplication ofbacterial keratitisbacterial keratitis

: "ue to the effect of"ue to the effect ofintra ocularintra ocularpressurepressure

: Associate! with Associate! withsever painsever pain



8anagement8anagement

9opical fortifie! !rops9opical fortifie! !rops Atropine sulphate Atropine sulphate

)ot fermentation)ot fermentation Analgesics with antaci!s Analgesics with antaci!sOrall aceta=olami!eOrall aceta=olami!e



ungal corneal ulcer ungal corneal ulcer

Infective mo!e # InBur with vegetativeInfective mo!e # InBur with vegetativematerial % thorn, branch of tree'material % thorn, branch of tree'

Common causative fungi are aspergillus,Common causative fungi are aspergillus,Can!i!a an! fusarium.Can!i!a an! fusarium.

4 mptoms same as for the bacterial ulcer 4 mptoms same as for the bacterial ulcer




!)*+!!)*+!"r looking"r looking@ellowish +white lesion with in!istinct@ellowish +white lesion with in!istinctmarginmargin"elicate, feather ,fingerlike proBections into"elicate, feather ,fingerlike proBections intothe a!Bacent stromathe a!Bacent stroma

?re ish halos 6 multiple satellite lesion?re ish halos 6 multiple satellite lesion4ome !egree of iri!oc clitis 6 h pop on4ome !egree of iri!oc clitis 6 h pop onare common.are common.




!iagram!iagram TreatmentTreatment 4crapping 64crapping 6!ebri!ment of the!ebri!ment of theulcer ulcer

Antifungal !rugs Antifungal !rugs%natam cin,nicon=ol%natam cin,nicon=ol

e 'e ' Atropine sulphates Atropine sulphates



Acanthamoeba keratitis Acanthamoeba keratitis

Acanthamoeba is a free living Acanthamoeba is a free living

proto=oa, it is foun! in stagnant water , C3proto=oa, it is foun! in stagnant water , C3solution an! C3 cases.solution an! C3 cases.




!#mptoms!#mptoms>lurre! vn>lurre! vn4evere pain4evere pain

!i'ns!i'ns 3imbitis3imbitisChronic 4tromalChronic 4tromalkeratitis +break!ownkeratitis +break!ownof corneal epitheliumof corneal epitheliumCorneal abscessCorneal abscess

which ma perforatewhich ma perforateNo!ular scleritis is aNo!ular scleritis is afreDuent fin!ingsfreDuent fin!ings




"iagram"iagram TreatmentTreatment >rolene !rops>rolene !rops6ointments6ointmentsNeom cin !ropsNeom cin !rops6ointment6ointment

In resistant cases,In resistant cases,a therapeutic *;a therapeutic *;ma be reDuire!ma be reDuire!



&iral keratitis&iral keratitis

Common viral infections inclu!eCommon viral infections inclu!e)erpes simplex keratitis)erpes simplex keratitis

)erpes =oster ophthalmicus)erpes =oster ophthalmicus A!enovirus keratitis A!enovirus keratitis



)erpes simplex keratitis)erpes simplex keratitis

Ocular involvement b )4& occurs in twoOcular involvement b )4& occurs in twoforms , primar 6 recurrent with followingforms , primar 6 recurrent with followinglesionslesions



)erpes simplex keratitis)erpes simplex keratitis

,rimar# herpes,rimar # herpesinfectioninfection

: 4kin lesions4kin lesions

: Acute follicular Acute follicularconBunctivitisconBunctivitis

: ine epithelialine epithelialpunctuate keratitispunctuate keratitis

: Coarse epithelialCoarse epithelialpunctuate keratitispunctuate keratitis

: "en!ritic ulcer "en!ritic ulcer

Recurrent herpesRecurrent herpesinfectioninfection

: Active epithelial Active epithelial

keratitis # !en!ritic 6keratitis # !en!ritic 6geographical ulcersgeographical ulcers

: 4tromal keratitis +4tromal keratitis +!isciform keratitis.!isciform keratitis.



"en!ritic keratitis"en!ritic keratitis

!#mptoms!#mptoms : Acute pain Acute pain:

Re!nessRe!ness: 3acrimation3acrimation: *hotophobia*hotophobia

: >lurring of vn>lurring of vn

!i'ns!i'ns : Circum CiliarCircum Ciliar

congestioncongestion

: Initiall spks an! theInitiall spks an! theto form erosionsto form erosions

: 9he erosions coalesce9he erosions coalesceto form !en!riticto form !en!ritic

: Corneal sensation isCorneal sensation is!iminishe! or absent!iminishe! or absent



"en!ritic keratitis"en!ritic keratitis

TreatmentTreatment : "ebri!ment of"ebri!ment of

the ulcer the ulcer : Anti viral agents Anti viral agents: Atropine or Atropine or

homatropinehomatropine



?eographical keratitis?eographical keratitis

"iagram"iagram 3arger epithelial3arger epitheliallesionlesion

9 pical geographical9 pical geographicalconfigurationconfiguration

Enlargement ofEnlargement of!en!ritic ulcer.!en!ritic ulcer.



"isciform keratitis"isciform keratitis

It is a !eep keratitis with !isc like oe!ema mainlIt is a !eep keratitis with !isc like oe!ema mainlcause! b herpes viruscause! b herpes virus

(linical features(linical features

: ocal !isc shape!ocal !isc shape!: 4tromal oe!ema4tromal oe!ema: "escemet s fol!s"escemet s fol!s:

"eep vascularisation"eep vascularisation

: >ullous keratopath>ullous keratopath: absent or !iminishe! corneal sensationabsent or !iminishe! corneal sensation



"isciform keratitis"isciform keratitis

TreatmentTreatment : )eal an)eal an

associate!associate!epithelial lesionepithelial lesion

: 9opical9opicalcorticosteroi!scorticosteroi!s

un!er antiviralun!er antiviralcovercover: C cloplegicsC cloplegics



)erpes =oster ophthlmicus)erpes =oster ophthlmicus

It is a common infection cause! b theIt is a common infection cause! b thevaricella + =oster virus. 9he infectionvaricella + =oster virus. 9he infectionmainl effects the el!erl pts.mainl effects the el!erl pts.

!#mptoms!#mptoms 55&esicular eruptions aroun! the e e ,&esicular eruptions aroun! the e e ,forehea! an! scalpforehea! an! scalp4ever pain4ever pain*hotophobia 6 lacrimation*hotophobia 6 lacrimation



4igns4igns

4tage I4tage I: *unctate epithelial keratitis*unctate epithelial keratitis: 8icro !en!rites8icro !en!rites

: Nummular keratitisNummular keratitis: "isciform keratitis"isciform keratitis: 4ensation is !iminishe! or absent4ensation is !iminishe! or absent4tage II4tage II: Nummular 6 "isciform keratitisNummular 6 "isciform keratitis4tage III4tage III: Nummular keratitisNummular keratitis



)erpes =oster ophthalmicus)erpes =oster ophthalmicus

Numular !iagramNumular !iagram TreatmentTreatment: Oral ac clovir Oral ac clovir : 4trong analgesics4trong analgesics: Antibiotic Antibiotic

corticosteroi!scorticosteroi!s: 9opical steroi!s9opical steroi!s: 9opical antibiotics9opical antibiotics: c cloplegicsc cloplegics



"ifferentiating features bFw"ifferentiating features bFw).simplex 6 ).Goster keratitis).simplex 6 ).Goster keratitis

-.!implex-.!im plex: "en!ritic ulcer + thin,"en!ritic ulcer + thin,

branching, withbranching, with

terminal bulbsterminal bulbs: Corneal sensationCorneal sensation!ecrease!!ecrease!

: 8il! iritis8il! iritis

-. oster -. oster : "en!ritic ulcer +"en!ritic ulcer +

coarse , noncoarse , non

branching, nobranching, noterminal bulbs, stainterminal bulbs, stainpoorl withpoorl withfluoresceinfluorescein

:Corneal sensationCorneal sensationmarke!l !ecrease!marke!l !ecrease!

: iritisiritis



Exposure keratitisExposure keratitis

(linical features(linical features: Epithelial erosionsEpithelial erosions

to sever ulcerationto sever ulceration: 4econ!ar4econ!ar

infection 6 eveninfection 6 evenperforationperforation

: 9he lower thir! of9he lower thir! ofthe cornea isthe cornea iscommonl affecte!commonl affecte!..

"iagram"iagram



*eripheral keratitis*eripheral keratitis



8arginal keratitis8arginal keratitis

!#mptoms!#mptoms: 8il! ocular irritation8il! ocular irritation: 3acrimation3acrimation: *hotophobia*hotophobia

!i'ns!i'ns

: 4ub#epithelial infiltrates at4ub#epithelial infiltrates atthe peripherthe peripher

: 4eparate! from the4eparate! from the

limbuslimbus: 3esion sprea!3esion sprea!circumferentiallcircumferentiall

: orm a fluoresceinorm a fluoresceinstaining ulcer staining ulcer

: Corneal sensation isCorneal sensation isunaffecte!unaffecte!



8arginal keratitis8arginal keratitis

9reatment9reatment: 9opical corticosteroi!s9opical corticosteroi!s: 8il! c cloplegics8il! c cloplegics: Rx of blepharitis toRx of blepharitis to

prevent recurrenceprevent recurrence



8ooren s ulcer 8ooren s ulcer

4I?N44I?N4: 4tarts at the palpebral area ,patches of4tarts at the palpebral area ,patches of

gre infiltrates at the margingre infiltrates at the margin: 4lowl un!ermining the epithelium 64lowl un!ermining the epithelium 6

superficial stromasuperficial stroma: It involves the entire circumference of theIt involves the entire circumference of the

corneacornea: )ealing + peripher + heale! area)ealing + peripher + heale! area

vascularise! ,thinne! 6 opaDuevascularise! ,thinne! 6 opaDue




4 mptoms4 mptoms: 4ever pain4ever pain: *hotophobia*hotophobia: 3acrimation3acrimation: "ecrease! the vn +"ecrease! the vn +

irregular astigmatism.irregular astigmatism.




9reatment9reatment: 9opical corticosteroi!9opical corticosteroi!:

C cloplegicsC cloplegics: ConBunctival excisionConBunctival excision: >C3>C3

: 4 stemic corticosteroi!s4 stemic corticosteroi!s



Corneal "egeneration 6Corneal "egeneration 6" strophies" strophies

"egenerations"egenerations: <suall unilateral 6<suall unilateral 6

as mmetricalas mmetrical: 3ocate! peripher3ocate! peripher: accompanie! baccompanie! b

vascularisationvascularisation: No inheritance patternNo inheritance pattern: Onset + mi!!le life orOnset + mi!!le life or

laterlater: 4econ!ar to4econ!ar to

compromising factorscompromising factors

" strophies" strophies: >ilateral 6 s mmetrical>ilateral 6 s mmetrical: 3ocate! centrall3ocate! centrall: No vascularisationNo vascularisation: )ere!itar)ere!itar: Earl in onsetEarl in onset: <nrelate! to an s stemic<nrelate! to an s stemic

or local !isease oror local !isease orcon!itioncon!ition



Arcus senilis Arcus senilis

it is bilateral lipi! !egeneration of peripheralit is bilateral lipi! !egeneration of peripheralcornea, affecting the most el!erl persons.cornea, affecting the most el!erl persons.



>an! keratopath>an! keratopath

It is !eposition of calcium salts in the subIt is !eposition of calcium salts in the subepithelial la er of the cornea ,6 isepithelial la er of the cornea ,6 ischaracterise! b a hori=ontal ban!characterise! b a hori=ontal ban!shape! opacit .shape! opacit .



Anterior ! stroph Anterior ! stroph

: 8ost of pts8ost of ptsas mptomaticas mptomatic

: >ut the others +>ut the others +

recurrent cornealrecurrent cornealerosionserosions

: *hotophobia 6*hotophobia 6lacrimationlacrimation

: &isual loss&isual loss



4tromal ! strophies4tromal ! strophies

?ranular ! strophies?ranular ! strophies: 4tarts + pubert ,4tarts + pubert ,

progresses ver slowlprogresses ver slowl: "iscrete, crumb like white"iscrete, crumb like white

granule + ant. 4troma ofgranule + ant. 4troma ofthe central corneathe central cornea: As mptomatic As mptomatic: ew pts complain of lightew pts complain of light

scatteringscattering




8acular ! strophies8acular ! strophies: 4tarts + earl life with4tarts + earl life with

significant impairment ofsignificant impairment ofvnvn

: 3esions are focal ,gre +3esions are focal ,gre +white ,poorl !efine!white ,poorl !efine!opacit in clou! stromaopacit in clou! stroma

: 3esions sprea! to the3esions sprea! to theentire corneal stromaentire corneal stromainclu!ing the peripheralinclu!ing the peripheralcornea.cornea.




3attice ! stroph3attice ! stroph: *resents in earl life*resents in earl life

with recurrentwith recurrent

erosionserosions

: 3esions are branching3esions are branchingspi!er like !eposits inspi!er like !eposits inthe stromathe stroma

: "iffuse corneal ha=e"iffuse corneal ha=e: Corneal sensationCorneal sensation

!iminishe!!iminishe!



*osterior ! strophies*osterior ! strophies

Corneal guttataCorneal guttata: Common agingCommon aging

processprocess

: ExcrescencesExcrescencesforme! b a stresse!forme! b a stresse!en!otheliumen!othelium

: "isrupt the normal"isrupt the normalen!othelial mosaic 6en!othelial mosaic 6appears a !ark spot.appears a !ark spot.



*osterior ! strophies*osterior ! strophies

uchs en!othelialuchs en!othelial! stroph! stroph

: Affect in el!erl Affect in el!erl

peoples + femalespeoples + females: Corneal guttataCorneal guttata: En!othelialEn!othelial

!ecompensation!ecompensation: Epithelial oe!ema 6Epithelial oe!ema 6

bullous keratopath .bullous keratopath .



Ectatic con!ition of corneaEctatic con!ition of cornea



keratoconuskeratoconus

It is a bilateral conical protrusion of theIt is a bilateral conical protrusion of thecentral part of the cornea with thinning ofcentral part of the cornea with thinning ofits central an! inferior paracentral areas.its central an! inferior paracentral areas.

4@8*9O844@8*9O84: Impaire! vn + irregular m opicImpaire! vn + irregular m opic

astigmatismastigmatism



4igns4igns

Irregular retinoscopic reflexIrregular retinoscopic reflex"istortion of mires of keratometer "istortion of mires of keratometer

&ogt s straie&ogt s straie*rominent corneal nerves*rominent corneal nerves9hinning of the cornea with protrusion9hinning of the cornea with protrusion

8oonson s sign8oonson s signleischer s ringleischer s ring



;eratoconus;eratoconus

&ogt s straie&ogt s straie 8oonson s sign8oonson s sign



;eratoconus;eratoconus

leischer s ringleischer s ring



keratoconuskeratoconus

ComplicationComplication

: Acute h !rops Acute h !rops: Intolerance to C3Intolerance to C3

Acute h !rops Acute h !rops



9reatment9reatment

Rigi! C3Rigi! C3*igg + back C3*igg + back C3C1RC1RCH3CH3IN9AC4IN9AC4

*;*;"A3;"A3;

*E33 CI" 8AR?INA3*E33 CI" 8AR?INA3



*E33<CI" 8AR?INA3*E33<CI" 8AR?INA3"E?ENERA9ION"E?ENERA9ION

: Rare ,bilateral , marginal !egeneration.Rare ,bilateral , marginal !egeneration.: 9hinning involves in the inferior cornea.9hinning involves in the inferior cornea.: Ectasia above thinne! areaEctasia above thinne! area: Acute h !rops is complication Acute h !rops is complication

: No vascularisationNo vascularisation



*elluci! marginal !egeneration*elluci! marginal !egeneration

"iagram"iagram 9reatment9reatment: <suall not reDuire!<suall not reDuire!: Correction ofCorrection of

astigmatism b R?*astigmatism b R?*C3C3



Other corneal !isor!ersOther corneal !isor!ers



4uperficial *unctate keratitis4uperficial *unctate keratitis

It is scattere! all over the cornea, usuallIt is scattere! all over the cornea, usuall!ue to viral infection.!ue to viral infection.



4*;s4*;s

4 mptoms4 mptoms: IrritationIrritation: 3acrimation3acrimation: *hotophobia*hotophobia

4igns4igns: Epithelial opacities +Epithelial opacities +

scattere! all over thescattere! all over the

corneacornea: *oorl stain with*oorl stain with

fluoresceinfluorescein: 4ensation ma be4ensation ma be

!iminishe!!iminishe!: Ciliar congestionCiliar congestion



4uperior limbic keratoconBunctivitis4uperior limbic keratoconBunctivitis

9his is a bilateral chronic inflammation of the9his is a bilateral chronic inflammation of thesuperior tarsal an! bulbar conBunctiva withsuperior tarsal an! bulbar conBunctiva withoe!ema of the superior limbal conBunctiva.oe!ema of the superior limbal conBunctiva.



4uperior limbic keratoconBunctivitis4uperior limbic keratoconBunctivitis

4 mptoms4 mptoms: > sensation> sensation: *hotophobia*hotophobia: *ain*ain: 8ucoi! !ischarge8ucoi! !ischarge

4igns4igns: *apillar h pertroph*apillar h pertroph

of the superior tarsusof the superior tarsus

: ) peraemia 6) peraemia 6keratinisation of thekeratinisation of thesuperior bulbarsuperior bulbarconBunctiva.conBunctiva.

: *unctate epithelium 6*unctate epithelium 6filaments.filaments.



;eratomalacia;eratomalacia

9his is characteri=e! b a !esiccation an!9his is characteri=e! b a !esiccation an!subseDuent necrosis of the cornea !ue tosubseDuent necrosis of the cornea !ue tolack of &it . Alack of &it . A

cornea ppt

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